What is urethral cancer?
Urethral cancer is very rare compared to other types of cancer such as breast, prostate, bowel or lung cancer. The tumor develops in the urethra.
Urethral cancer can originate from different cells. Depending on where it develops in the urethra, it may be a urothelial carcinoma (the urothelium is the tissue that lines the inside of the urinary tract), squamous cell carcinoma (made of mucosal cells) or adenocarcinoma (made of glandular cells).
The symptoms of urethral carcinoma are often unspecific and often only appear at an advanced stage of the disease. These mainly consist of blood in the urine. Pain when urinating, a weak urinary stream and urinary dribbling in the sense of a bladder emptying disorder or a palpable tumor can also occur.
We usually treat urethral cancer with the help of an operation in which we remove part or all of the urethra. Sometimes surgeons also have to operate on the penis or the bladder. Chemotherapy and radiotherapy can also be helpful – depending on the stage of the cancer.
Unfortunately, there are no measures for the early detection of bladder cancer.
Urethral cancer – frequency and age
Urethral tumors account for only about 0.3 percent of all cancers. It usually occurs at the age of 75 and over.
Men are affected around three times as often as women, as figures from the US SEER database show: The disease affects around 4.3 men and 1.5 women per 1,000,000 inhabitants per year. The European project RARECARE (Surveillance of rare cancer in Europe) arrived at similar figures.
Urethral cancer: causes and risk factors
The causes of urethral cancer are still largely unknown. However, cancer always originates from the fact that the genetic material (DNA) of a cell changes – it mutates. It can then divide and multiply unchecked. Unlike healthy cells, cancer cells can invade surrounding tissue and spread to other organs via the blood and lymph channels. There they form cancer metastases.
We suspect some risk factors that may favor urethral cancer. These include, for example:
- Chronic irritation of the urethra, for example due to a catheter or after urethral surgery
- Repeated urethritis (inflammation of the urethra)
- Frequent urinary tract infections
- sexually transmitted diseases (STDs, venereal diseases)
- Narrowing of the urethra (urethral stricture)
- Injuries to the urethra
- Urethral caruncle: Benign tumor of the urethra that can degenerate
- Urethral diverticulum: A cavity that communicates with the urethra
- HPV infection (human papillomavirus type 16, but also 18)
- Radiotherapy in the past (external, internal)
Whether and to what extent these risk factors are involved in the development of urethral cancer has not yet been sufficiently scientifically proven. Researchers are still discussing what role these factors play in men and women.
Subdivision of the urethral tumor
Depending on the site of origin, different types of urethral carcinoma are distinguished with different frequencies of occurrence:
- Urothelial carcinoma: At 54 to 65 percent, it is the most common
- Squamous cell carcinoma (16 to 22 percent)
- Adenocarcinoma (10 to 16 percent).
Symptoms: Urethral cancer often goes unnoticed for a long time
The symptoms of urethral cancer are usually unspecific at first. Most people affected do not immediately associate their symptoms with this extremely rare type of cancer – and neither do we.
In addition, small tumors of the urethra often cause little or no discomfort. This is why we often find urethral cancer late, when the cancer is already more advanced. Incidental findings are very rare in people without symptoms. However, the larger the malignant tumor becomes, the more it eventually constricts the urethra, resulting in discomfort when urinating.
The following symptoms can occur with urethral cancer:
- Blood in the urine (hematuria) – this is usually the first symptom. There may be small amounts of blood in the urine that are not visible to the naked eye (microhaematuria). Larger amounts of blood in the urine (macrohaematuria), on the other hand, are visually recognizable – the urine turns reddish in colour.
- Increased urge to urinate
- Pain during urination
- Weak urine stream
- Urinary dribbling
- Discharge from the urethra, which can sometimes be bloody
- Pain in the pelvic area
- Pain during sex
- Sometimes urethral tumors are palpable
- Increased susceptibility to urinary tract infections because residual urine remains in the bladder due to urinary outflow disorders
- later general symptoms such as unwanted weight loss, night sweats, swollen legs due to lymph congestion (lymphoedema)
Urethral cancer: Diagnosis by us
The diagnosis of urethral cancer always begins with a medical history interview. We ask you some questions, for example:
- What are your symptoms?
- How long have the complaints existed?
- How intensively are they pronounced?
- Where exactly do you feel the discomfort?
- Do you frequently suffer from urethritis?
- Are repeated urinary tract infections known?
- Have doctors diagnosed an HPV infection? If yes: which type?
- Do you have any other known illnesses?
- Have you ever had cancer and have you undergone cancer treatment?
This is followed by a physical examination. In some cases, a tumor in the urethra can also be felt when it is already larger. In addition, the lymph nodes in the groin and pelvic region are palpated.
Urethral cancer – further examinations
This is usually followed by further examinations to detect a possible tumor in the urethra. The most important are:
- Urine test: This shows, for example, whether there is blood in the urine.
- Urine cytology: We analyze the cellular components of urine. Sometimes tumor cells can be detected there. However, urine cytology is not a very conclusive method.
- Urethral and bladder endoscopy (urethrocystoscopy): A thin, flexible instrument (cystoscope) equipped with a small camera and light source is inserted into the urethra and bladder. This is usually done under local anesthesia. This allows changes in the urethra and bladder to be detected.
- Tissue sample (biopsy): As part of the urethral endoscopy, tissue samples can be taken from a suspicious area at the same time. A pathologist then analyzes the cells under a microscope. This makes it possible to distinguish between benign and malignant cells. Conclusions can also be drawn about the type, size, aggressiveness and spread of the urethral cancer.
Imaging procedures for the diagnosis of urethral cancer
Imaging procedures help to determine the spread of the tumor. These include, among others:
- Ultrasound (sonography), for example of the pelvis and bladder. In men, a transrectal ultrasound is also used to assess the prostate. Transvaginal ultrasound is used for women.
- Computed tomography (CT) – a method that works with X-rays and provides detailed cross-sectional images. The CT shows the spread of urethral cancer to other organs in the body.
- Magnetic resonance imaging (MRI = magnetic resonance imaging): Radiologists use strong magnetic fields to obtain high-resolution cross-sectional images. This also allows the extent of the tumor to be determined.
- Positron emission tomography/CT (PET/CT): A whole-body image is taken in which possible spread to organs such as the lungs, liver or bones can be detected. PET/CT uses radioactively labeled sugar “18F-FDG” to find particularly metabolically active areas. In this way, even very small metastases can be visualized
Urethral cancer – classification into stages
Treatment and prognosis depend significantly on the exact staging. The so-called TNM classification is used.
- T (tumor): How large is the tumor?
- N (node): Are cancer cells present in the lymph nodes? If yes: local or further away or how large?
- M (metastases): Are metastases detectable in organs other than lymph nodes?
The TNM classification is used for staging. A tumor is assigned to a stage from zero to four. The higher the number, the more advanced the cancer.
In addition, the nature of the cancer tissue is analyzed and it is determined how similar the tumor cells are to healthy cells – this procedure is called grading. There are the differentiation grades “low-grade” (low deviation from the original tissue) and “high-grade” (high degeneration).
Urethral cancer forms metastases in other organs in around ten percent of cases. The lungs, liver, bones and brain are most frequently affected. Further complaints may then arise.
Urethral cancer: prevention, early detection, prognosis
The causes of urethral cancer are still largely unknown. Therefore, you cannot really prevent this type of cancer. However, experts associate urethral cancer with frequent urethritis and repeated urinary tract infections. You should therefore always have these illnesses adequately treated.
In addition, sexually transmitted diseases and infections with the human papillomavirus (HPV) could possibly play a role. You can protect yourself against these to a certain extent by using condoms/femidoms. “Safer sex” is the keyword. The general advice also applies: always seek medical advice promptly if you experience symptoms such as blood in your urine.
There are no targeted measures for the early detection of urethral cancer. This is certainly also due to the fact that this type of cancer is so rare. For common types of cancer such as breast cancer or skin cancer, on the other hand, screening measures are available for healthy people without symptoms.
Course and prognosis of urethral cancer
The course and prognosis of urethral cancer cannot be generally predicted. The decisive factor is how advanced the tumor in the urethra is at the time of diagnosis. The size, stage, aggressiveness and location of the tumor are important for the course of the cancer. In general, the earlier the cancer is detected, the better the treatment and the more favorable the prognosis.
The type of urethral cancer is also likely to play a role. Urothelial carcinoma appears to be associated with a less favorable prognosis than the other forms. The location of the tumor could also be important. A tumor near the urethral orifice may have a more favorable prognosis than tumors in the upper part of the urethra.
Urethral cancer: treatment depends on the stage
Which therapy is chosen always depends on the stage of the disease. Several types of treatment are usually used in combination. Specialists from several disciplines are usually involved in the treatment and plan the therapy together. These may include specialists in urology, gynecology, oncology and radiation oncology.
The most important treatment strategies for urethral cancer are:
- Surgery: In the case of smaller tumors, the urethra is partially or completely removed, depending on its size. If the cancer is already more advanced, sometimes the bladder has to be removed, and in men sometimes parts of the penis too.
- Radiotherapy (radiotherapy): Radiation oncologists use high-energy radiation. Radiotherapy is also suitable before an operation (neoadjuvant) to first reduce the size of the tumor so that it can be operated on more gently. It also helps after the operation to kill any remaining cancer cells.
- ChemotherapyCell toxins, the so-called cytostatics or chemotherapeutics, are used. They act throughout the body (systemically) and hinder the division and proliferation of cancer cells in different ways. In most cases, several cytostatic drugs are used to increase the effectiveness of the chemotherapy. These are administered in cycles – in between there are phases without medication in which the body can recover. Chemotherapy can be used before or after surgery/radiotherapy. In very advanced or metastatic stages, it is often the sole therapy.
- Radiochemotherapy: This is a combination of radiotherapy and chemotherapy.
- Psycho-oncology: Cancer not only affects the body, but also the psyche. Psycho-oncological support is now available for cancer patients and their relatives.
- Palliative care: This provides support in symptom optimization, expansion of home care and general support for patients and their relatives both in the early and late stages of the disease in addition to cancer treatment.
All therapies can cause side effects and complications that can be treated additionally. Examples include nausea and vomiting (with antiemetics), inflammation (with stomach protection, mouthwash, etc.) or bacterial infections (with antibiotics).
Following the therapy, a final clinical and imaging examination is carried out and then regular follow-up care is provided. Take advantage of these regular check-ups with us. They check your state of health and the success of the therapy, look for signs of a relapse (recurrence) and treat complaints, side effects and complications. Initially, the time intervals are shorter (e.g. every three months). If the urethral cancer has not returned over a longer period of time, this period increases.